Surgery In Prone Position Research Articles

Prone spine surgery in a morbidly obese patient: Anesthesia challenges and management

India is seeing a rapid epidemiological transition from underweight to overweight, with an overall prevalence of obesity reported to be 40.3%. Anesthesiology concerns in an obese patient are well known. We elaborate on the anesthesia management in a 68-year-old male patient with a body mass index of 66.3 kg/m2 who underwent spine surgery in prone position. Challenges faced ranged from the size of the table to the difficult airway, difficulty in positioning, maintenance of airway and ventilation, maintaining a free abdomen, and anesthesia management with meticulous use of anesthetic drugs for an uneventful recovery.

A Study to Evaluate Changes in Modified Mallampati Class in Patients Undergoing Spine Surgery in Prone Position.

Background: Perioperative airway changes due to anesthesia and surgery could change a normal airway at induction to a risky airway at extubation.Objectives: The objective is to evaluate primarily the degree of airway changes, as quantified by the modified Mallampati (MMP) class, after spine surgery in the prone position. Secondary to assess the time required for these changes to revert back to the preoperative state and their correlation with other demographic and surgical variables.Methods: The present prospective observational study was conducted in a tertiary care hospital after ethical approval and trial registration. Fifty ASA I and II patients aged 18-65 years of both sex and undergoing spine surgery in prone positions were included. Supine MMP grade was observed preoperatively and at one, two, four, 24, and 48 hours postoperatively.Statistical analysis: IBM SPSS version 22 (IBM Corp, Armonk, NY) was used.Mean values were compared using paired t-tests and medians by the Wilcoxon test. The Spearman correlation was used to assess a relationship. The time for recovery was analyzed by Kaplan-Meir analysis.Results: An increase in MMP grade was observed at one hour postoperatively in 46 (92%) patients. Changes reverted back in 45 (98%) patients by 24 hours postoperatively. A weak positive correlation with age, weight, body mass index, duration of surgery, perioperative drop in hemoglobin, and a moderate positive correlation with fluid administered and estimated blood loss was recorded.Conclusions: An increase in postoperative MMP occurs in the majority of patients undergoing prone position spine surgery which may persist up to 48 hours. So, more vigilance and caution are warranted should reintubation be needed postoperatively.

Abstract No.: ABS0586: Is pressure control ventilation better than volume control in patients undergoing spine surgery in prone position?

Background & Aims:Optimisation of intraoperative ventilation is feasible nowadays due to availability of several new modes in anaesthesia workstations. Spine surgery in prone position leads to pulmonary and haemodynamic alterations. The present study aimed to compare PCV and VCV modes of ventilation in patients undergoing spine surgeries.Methods:After obtaining approval from institutional ethics committee the present, prospective, randomised study was conducted in 50 adult patient of either sex, ASA I or II undergoing thoracic or lumbar spine surgery in prone position. Standard anaesthesia protocols using Thiopentone, Fentanyl and Vecuroniun was followed. Patients in VCV group (n=25) were ventilated with volume control mode with TV = 7 ml/kg, PEEP=5cm H2O, I: E=1:2 and respiratory rate adjusted to keep Et CO2 between 35-40 mmHg and FiO2 =0.4. While in PCV mode (n=25) patients were ventilated with similar settings except PIP was adjusted to determine TV=7ml/kg. Draeger Primus workstation was used.Results:Demographic profile, duration of surgery, intraoperative dry and fluid consumption were comparable in two groups. Peak inspiratory pressure was higher in VCV (20 vs 18) and dynamics compliance was low in VCV (31.3 vs 35.93). Minute ventilation, EtCO2, dead space, O2 saturation was comparable in two groups though alveolar oxygenation was better in PCV. Diastolicblood pressure was low in VCV. Postoperative PFT decreased in both groups but were comparable.Conclusion:PCV is better than VCV in maintaining intraoperative respiratory mechanisms but whether they offer long term benefit require more studies comprising of larger sample sizes.

Abstract No.: ABS1770: Cuffed versus uncuffed endotracheal tubes in infants undergoing elective surgery in prone position:peritubal leak at standardised ventilator settings

Background & Aims:The purpose of this study was to compare peritubal leak in cuffed and uncuffed tubes in infants at standardised ventilatorsettings. Secondary objective was to see incidence of accidental extubation and postoperative respiratory complications such as stridor and sore throat.Methods:With ethics committee approval, a prospective,randomised,clinical study was conducted. Patients aged between birth to 1 year, American Society of Anesthesiologists ASA grade I,II and III, requiring general anaesthesia with orotracheal intubation in prone position during elective surgery were included and children with parents not giving consent,children with airway anomaly, laparoscopic surgery, and emergency surgery were excluded. Tracheal tube size was judged as adequate if the leak pressure was 20 cm H2O or less. Tube was exchanged to next larger size if the leak pressure was too high and tube size was exchanged to next smaller size, when cuff pressure exceeded 20 cm H2O.Results:60 infants were studied.In group 1 in which cuffed tube was used, there were no leaks,on the other hand, in group 2,17 out of 30 patients had peritubal leak and tube was exchanged to next larger size uncuffed tube, p value was <0.001. Moreover, the incidenceof accidental extubation, post extubation sore throat and stridor was more in uncuffed group, It was 2/6/6 in uncuffed group and 0/3/4 in cuffed group respectively. Tracheal tube exchange rate was also higher in uncuffed group.Conclusion:We found that in microcuff paediatric endotracheal tube, there is less peritubal leak; selection of cuffed tube with small internal diameter compared to uncuffed tubes implicates a higher chance for adequate fit of the tube at cricoid ring and due to this there is least chance of accidental extubation in the prone position.Peritubal leakGroup I (n=30)Group II (n=30)Total (n=60) No.%No.%No.%Absent30100.01343.34371.7Present00.01756.71728.3

Relationship between pulse pressure variation and stroke volume variation with changes in cardiac index during hypotension in patients undergoing major spine surgeries in prone position - A prospective observational study.

Dynamic indices such as pulse pressure variation (PPV) and stroke volume variation (SVV) are better predictors of fluid responsiveness than static indices. There is a strong correlation between PPV and SVV in the prone position when assessed with the fluid challenge. However, this correlation has not been established during intraoperative hypotension. Our study aimed to assess the correlation between PPV and SVV during hypotension in the prone position and its relationship with cardiac index (CI). Thirty patients aged 18-70 years of ASA class I-III, undergoing spine procedures in the prone position were recruited for this prospective observational study. Hemodynamic variables such as heart rate (HR), mean arterial pressure (MAP), PPV, SVV, and CI were measured at baseline (after induction of anesthesia and positioning in the prone position). This set of variables were collected at the time of hypotension (T-before) and after correction (T-after) with either fluids or vasopressors. HR and MAP are presented as median with inter quartile range and compared by Mann-Whitney U test. Reliability was measured by intraclass correlation coefficients (ICC). Generalized estimating equations were performed to assess the change of CI with changes in PPV and SVV. A statistically significant linear relationship between PPV and SVV was observed. The ICC between change in PPV and SVV during hypotension was 0.9143, and after the intervention was 0.9091 (P < 0.001). Regression of changes in PPV and SVV on changes in CI depicted the reciprocal change in CI which was not statistically significant. PPV is a reliable surrogate of SVV during intraoperative hypotension in the prone position.

The effects of body mass index on intraabdominal pressure and regional cerebral oxygen saturation in lumbar spine surgery in prone position

The effects of body mass index on intraabdominal pressure and regional cerebral oxygen saturation in lumbar spine surgery in prone position

Venous air embolism during meningomyelocele repair surgery in prone position

Venous air embolism during meningomyelocele repair surgery in prone position

Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

IntroductionThe term pneumocephalus refers to the existence of air in any intracranial compartment. Its presence in the follows of a supratentorial craniotomy is very common, and it usually represents a benign complication as it is very rarely responsible for clinical manifestations.Case presentationWe report the case of a 24 years-old man, who underwent posterior fossa surgery in prone position for resection of a vermian tumor. Postoperative, the patient presented a tonic-clonic generalized seizure associated to high levels of arterial pressure and decerebration. Control CT scan showed an important pneumocephalus. On the posterior fossa, the air was responsible for a compression of the brainstem, without any other postoperative complications. Following 12 h of conservative management, a brain MRI showed a total regression of the pneumocephalus. 3 days later, the patient presented a favorable outcome as he was extubated without any major impairments.DiscussionTransformation of pneumocephalus into tension pneumocephalus responsible for clinical inadvertance is rare. This complication is mainly related to surgeries performed in sitting position. The occurrence of compressive pneumocephalus after a posterior fossa craniotomy performed in a prone position is seldom.ConclusionsThrough this case, we discuss pathophysiology and therapeutic approaches for tension pneumocephalus following posterior fossa performed in prone position.

Changes in stroke volume induced by lung recruitment maneuver can predict fluid responsiveness during intraoperative lung-protective ventilation in prone position

BackgroundThe present study aimed to evaluate the reliability of hemodynamic changes induced by lung recruitment maneuver (LRM) in predicting stroke volume (SV) increase after fluid loading (FL) in prone position.MethodsThirty patients undergoing spine surgery in prone position were enrolled. Lung-protective ventilation (tidal volume, 6–7 mL/kg; positive end-expiratory pressure, 5 cmH2O) was provided to all patients. LRM (30 cmH2O for 30 s) was performed. Hemodynamic variables including mean arterial pressure (MAP), heart rate, SV, SV variation (SVV), and pulse pressure variation (PPV) were simultaneously recorded before, during, and at 5 min after LRM and after FL (250 mL in 10 min). Receiver operating characteristic curves were generated to evaluate the predictability of SVV, PPV, and SV decrease by LRM (ΔSVLRM) for SV responders (SV increase after FL > 10%). The gray zone approach was applied for ΔSVLRM.ResultsAreas under the curve (AUCs) for ΔSVLRM, SVV, and PPV to predict SV responders were 0.778 (95% confidence interval: 0.590–0.909), 0.563 (0.371–0.743), and 0.502 (0.315–0.689), respectively. The optimal threshold for ΔSVLRM was 30% (sensitivity, 92.3%; specificity, 70.6%). With the gray zone approach, the inconclusive values ranged 25 to 75% for ΔSVLRM (including 50% of enrolled patients).ConclusionIn prone position, LRM-induced SV decrease predicted SV increase after FL with higher reliability than traditional dynamic indices. On the other hand, considering the relatively large gray zone in this study, future research is needed to further improve the clinical significance.Trial registrationUMIN Clinical Trial Registry UMIN000027966. Registered 28th June 2017.

A study to evaluate ocular changes in patients undergoing spine surgery in the prone position.

Background and Aims:AA present prospective study was conducted to evaluate ocular changes occurring in patients undergoing spine surgery in the prone position.Material and Methods:A total of 44 patients of either sex, belonging to American society of Anaesthesiology I and II (aged 18-60 years) scheduled for elective spine surgery in prone position were enrolled in the study. Baseline IOP and MAP measurement were taken prior to induction. After induction of anaesthesia patients were intubated using flexo-metallic tube of appropriate size. IOP and MAP were recorded after induction of anaesthesia, following completion of surgery and immediately after turning the patient supine and 30 min following extubation. Blood loss and duration of surgery was also noted. The OPP was derived using the formula (OPP = MAP-IOP). Ophthalmic examination was also performed using direct and indirect ophthalmoscopy on the day prior to surgery and on first post-operative day to rule out anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), and retinal ischemia.Results:Mean IOP significantly increased (18.91 ± 3.56 mm Hg) (P < 0.001) at the end of surgery as compared to baseline value 12.85 ± 3.07 mm Hg. As a result mean OPP significantly reduced (75.12 ± 16.45) (P = 0.0018) at the end of the procedure.Conclusion:In patient’s undergoing spine surgery in the prone position, careful patient positioning with no extrinsic pressure on the eyes, minimal surgical time and blood loss, and prevention of intraoperative hypotension, should be ensured to prevent the IOP rise and a reduction in OPP which can further prevent post-operative visual disturbance.

The Effect of Goal-Directed Fluid Therapy versus Standard Fluid Therapy on the Cuff Leak Gradient in Patients Undergoing Complex Spine Surgery in Prone Position.

Objective Cuff leak test is an effective and established maneuver to predict airway edema. Standard fluid therapy (SFT) based on conventional monitoring is often associated with postoperative airway edema after complex spine surgeries. We conducted this prospective randomized controlled study to compare the effect of SFT versus goal-directed fluid therapy (GDFT) on the cuff leak gradient (CLG) in patients undergoing complex spine surgery in prone position. Our secondary objectives were to compare the effect of SFT and GDFT on sore throat, hoarseness, and length of intensive care unit (ICU) and hospital stay. Materials and Methods Thirty consecutive American Society of Anesthesiologists physical status I and II patients (18–60 years), of either sex, scheduled for spine surgery in prone position with expected duration of surgery more than 5 hours were included. The patients were randomized into two groups of 15 each. Group S patients ( n = 15) served as control group and received SFT intraoperatively, while patients in group G ( n = 15) received GDFT. Standard anesthetic protocol was followed in both the groups. The CLG was defined as the difference between the cuff leak volume (CLV) after intubation (CLV AI ) and before extubation (CLV BE ). Statistical Analysis and Results CLG was significantly less in group G (group S, 137.12 mL; group G, 65.52 mL; p -value <0.001). Intravenous fluids, blood loss, and postoperative sore throat were comparatively lesser in group G, though not statistically significant. Postoperative hoarseness was significantly lower in group G ( p -value = 0.003). Duration of ICU stay in group G (19.43 hours) was significantly lower ( p -value = 0.009) than group S (24.64 hours), but length of hospital stay was comparable. Conclusion GDFT significantly reduces airway edema and consequently reduces CLG as compared with SFT in patients undergoing complex spine surgery in prone position. Postoperatively, it also reduces sore throat, hoarseness of voice, and duration of ICU stay.

212 USEFULNESS OF ENDOSCOPIC ESOPHAGECTOMY IN A PRONE POSITION FOR ELDERLY PATIENTS OVER 75 YEARS OLD

Abstract Surgery for esophageal squamous cell carcinoma(ESCC) is one of the most invasive surgery and high mortality rate because operation is centered on the thoracic cavity. Recently, Japan has been facing aging society, and surgery for elderly ESCC patient is increasing. In our hospital, we changed surgical position from left lateral position to prone. In this study, we investigated the surgical outcome and prognosis of ESCC operation in the patients aged ≧ 75. Methods From April 2011 to March 2019, 39 ESCC operations for patients aged ≧ 75 were performed in our hospital. We compered surgical position. We retrospectively examined clinicopathological factors, long-term prognosis, preoperative nutritional status (albmin, neutrophil and lymphocyte ratio), and operation factors (operation time, blood loss, recurrent nerve paralysis, complication, hospital stay). Results Cases in lateral position surgery were 22 and prone position were 17. The median age was 79 vs 79 years old, and the gender ratio was male: female = 16:6/14:3. No significant differences were observed in preoperative nutritional status. The operation time was 458 min vs 501 min (p = 0.126). The blood loss was 318 mL vs 195 mL (p = 0.003). The rate of recurrent nerve paralysis was 42.1% vs 29.4% (p = 0.262). The number of patients in Clavien-Dindo ≧ III complications was 40.9% vs 41.2% (p = 0.987). 3-year OS was 74.7% vs 77.3%, DFS was 78.6% vs 67.7%. Conclusion In ESCC patients aged ≧ 75, surgery in prone position was relatively safe. The blood loss and the recurrent nerve paralysis ware tend to be less. Recurrent nerve monitoring during operation and evaluation of perioperative swallowing function seemed to be the next subject.

A Comparative Study of Extubation in Prone and Supine Position in Patients Undergoing Lumbar Spine Surgery in Prone Position

Aim: In case of surgeries done in prone position, patients are rolled to supine during extubation which is associated with loss of monitoring and hemodynamic change. Also, incidence of coughing and bucking are noted. Several studies have shown that prone position extubation is associated with reduced frequency of coughing and monitor disconnection in prone position surgeries. The purpose of this study was to compare the safety and efficacy of patients extubated in prone and supine posted for lumbar spine surgery.&#x0D; Study Design: 60 patients varying from age 18 - 65 years and posted for lumbar spine surgery under general anaesthesia in prone position were randomly allocated to any one of the two groups Group P - In this group extubation was done in prone position at the end of surgery or Group S – In this group extubation was done in supine position at the end of surgery.&#x0D; Place and Duration of Study: Jawaharlal Nehru Medical College, DMIMS (DU), Acharya Vinoba Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha over the period of 1 year (2019 - 2020).&#x0D; Methods: A double blinded randomized controlled comparative study was conducted on 60 patients with primary objective to measure incidence of coughing and severity of coughing in prone vs supine extubation. Patients were anesthetized with fentanyl, nitrous oxide, sevoflurane, and vecuronium. Neuromuscular blockade was reversed in prone position and all patients had spontaneous ventilation at the conclusion of surgery. At time 0, patients were randomly divided into group P or group S. Patients in the group S were then rolled over, while those in the prone position remained undisturbed. Frequency of cough, monitor disconnection and changes in heart rate (HR) and mean arterial pressure (MAP) were noted during extubation. Patient were extubated on purposeful behaviour and eye opening.&#x0D; Results: Frequency of coughing was significantly less in prone patients in comparison to supine group (6 vs. 24 coughs) monitor disconnections dysconnectivity was also fewer (p &lt; 0.001), little change in haemodynamics was noted during extubation. Time to extubation from time 0 was comparatively more in Group S. Airway rescue was not needed.&#x0D; Conclusions: Extubation in prone position is associated with lesser frequency of coughing, disruption of monitors and significantly less hemodynamic changes as compared to supine position extubation he abstract should be concise and informative. It should not exceed 300 words in length. It should briefly describe the purpose of the work, techniques and methods used, major findings with important data and conclusions. Different sub-sections, as given below, should be used. No references should be cited in this part. Generally non-standard abbreviations should not be used, if necessary they should be clearly defined in the abstract, at first use.

Management of anesthesia for surgery in prone position for a patient with hereditary neuropathy with liability to pressure palsies. A case report and narrative literature review

The reported case describes a patient with hereditary neuropathy with liability to pressure palsies (HNPP) requiring a neurosurgical laminotomy procedure for an arachnoid cyst with medullary compression. HNPP is a rare pathology requiring meticulous anesthetic and surgical management. We give a detailed overview of the planning, simulation, and performance of the anesthesia procedure in order to minimize all potential risk factors for perioperative nerve injury. During the preparation of this case, where the positioning was extremely challenging, we reviewed the available literature for guidance. A few papers report the use of neuraxial anesthesia in patients previously diagnosed with HNPP. No reports could be found on the management of general anesthesia and positioning for major surgery in those patients.

Risk factors of meralgia paresthetica after prone position surgery: Possible influence of operating position, laminectomy level, and preoperative thoracic kyphosis

Obesity and a prolonged surgical duration are reported risk factors for meralgia paresthetica (MP) after prone position surgery; however, this fails to explain why MP seldom occurs after prone position craniotomy. We reviewed the incidence of MP after spinal surgery and craniotomy in the prone position and investigated whether unidentified factors are involved in the mechanism of postoperative MP. Between January 2014 and March 2020, we performed 556 prone position surgeries. We excluded patients aged ≤16 years and those who were comatose or who required redo-surgery, and reviewed 446 eligible patients (124 who underwent craniotomies and 322 who underwent posterior spinal surgeries). Postoperative MP occurred in 46 (10.3%) patients with a higher incidence after spinal surgery than after craniotomy (13.7% vs. 1.6%, p < 0.001). Among the 322 patients who received posterior spinal surgery, thoracic and lumbar laminectomies were associated with a higher incidence of MP than cervical laminectomy. Analyses limited to those patients who received thoracic and lumbar laminectomies revealed that the preoperative thoracic kyphosis (TK) angle was significantly greater in patients with MP than in those without MP (average TK angle, 38.9° vs. 23.1°; p < 0.001), and that the preoperative lumbar lordosis angle did not significantly differ between the two groups. Apart from the known predisposing factors, we found that thoracolumbar-sacral laminectomy in patients with a greater TK angle is also a risk factor for MP after prone position surgery.

Comparison of upper and lower body forced air blanket to prevent perioperative hypothermia in patients who underwent spinal surgery in prone position: a randomized controlled trial

BackgroundWe compared upper- and lower-body forced-air blankets in terms of their ability to prevent perioperative hypothermia, defined as a reduction in body temperature to < 36.0°C, during the perioperative period in patients undergoing spine surgery in the prone position.MethodsIn total, 120 patients scheduled for elective spine surgery under general anesthesia were divided into an upper-warming group (n = 60) and a lower-warming group (n = 60). After inducing anesthesia and preparing the patient for surgery, including prone positioning, the upper and lower bodies of the patients in the upper- and lower-warming groups, respectively, were warmed using a forced-air warmer with specified upper and lower blankets. Body temperature was measured using a tympanic membrane thermometer during the pre- and post-operative periods and using a nasopharyngeal temperature probe during the intraoperative period. Patients were evaluated in terms of shivering, thermal comfort, and satisfaction in the post-anesthesia care unit (PACU).ResultsThe incidence of intraoperative and postoperative hypothermia was lower in the upper-warming group than in the lower-warming group ([55.2% vs. 75.9%, P = 0.019] and [21.4% vs. 49.1%, P = 0.002]). Perioperative body temperature was higher in the upper-warming group (P < 0.001). However, intraoperative blood loss, postoperative thermal comfort scale and shivering scores, patient satisfaction, and PACU duration were similar in the two groups.ConclusionsThe upper-body blanket was more effective than the lower-body blanket for preventing perioperative hypothermia in patients who underwent spine surgery in the prone position.

Single-Position Prone Lateral Interbody Fusion Improves Segmental Lordosis in Lumbar Spondylolisthesis

Single-position surgery in prone position is a novel technique for lateral interbody fusion with pedicle screw fixation. We performed a radiographic comparison of patients treated for spondylolisthesis using the prone lateral (PL) transpsoas approach versus the traditional dual position (DP) approach (lateral decubitus then prone). Thirty consecutive patients with spondylolisthesis were treated using the PL approach (n= 15) versus the dual position approach (n= 15). Radiographic factors in the groups were retrospectively compared. The groups were similar for age, sex, body mass index, and implant size, but there were more 15° (vs. 10°) cages inserted in the dual position group. Radiographically the groups had similar baseline spinopelvic parameters, lumbar lordosis (LL), segmental lordosis, anterolisthesis, and disc height (P > 0.05). Postoperatively the PL group demonstrated a larger improvement in segmental lordosis (5.1° vs. 2.5°, P= 0.02), but not overall LL (6.3° vs. 3.1°, P= 0.14). Both groups had similar improvements in pelvic tilt, disc height, and spondylolisthesis reduction (P > 0.05). The mean relative distance of the implant from the posterior edge of the vertebral body was greater in the PL group (26% vs. 17%, P < 0.001) indicating a tendency for more anterior cage placement. However, there was no significant correlation between the relative cage position and the increase in segmental lordosis (P= 0.35), so this result alone did not explain the relative increase in lordosis seen. This is the first study to our knowledge to demonstrate an improvement in segmental lordosis for patients with single-level spondylolisthesis using the PL approach.

Effects of ventilation mode type on intra-abdominal pressure and intra-operative blood loss in patients undergoing lumbar spine surgery: A randomised clinical study.

Background and Aims:The aim of the study was to evaluate the effect of mode of mechanical ventilation; pressure-controlled ventilation (PCV) vs. volume-controlled ventilation (VCV) on airway pressures, intra-abdominal pressure (IAP) and intra-operative surgical bleeding in patients undergoing lumbar spine surgery.Methods:This was a prospective, randomised study that included 50 American Society of Anesthesiologists class I and II patients undergoing lumbar spine surgery who were mechanically ventilated using PCV or VCV mode. The respiratory parameters (peak and plateau pressures) and IAP were measured after anaesthesia induction in supine position, 10 min after the patients were changed from supine to prone position, at the end of the surgery in prone position, and after the patients were changed from prone to supine position. The amount of intraoperative surgical bleeding was measured by objective and subjective methods.Results:The primary outcome was the amount of intraoperative surgical bleeding. It was significantly less in the PCV group than in the VCV group (137 ± 24.37 mL vs. 311 ± 66.98 mL) (P = 0.000). Similarly, on comparing other parameters like peak inspiratory pressures, plateaupressures and IAP, the patients in PCV group had significantly lower parameters than those in VCV group (P < 0.05). No harmful events were recorded.Conclusion:In patie,nts undergoing lumbar spine surgery, use of PCV mode decreased intraoperative surgical bleeding, which may be related to lower intraoperative respiratory pressures and IAP.

A Rare Cause of Inguinal Hernia Recurrence: Herniation After Lumbar Spinal Surgery in Prone Position

A Rare Cause of Inguinal Hernia Recurrence: Herniation After Lumbar Spinal Surgery in Prone Position

Risk Factors for Facial Pressure Ulcers in Patients Who Underwent Prolonged Prone Orthopedic Spine Surgery.

This study evaluated incidence and risk factors associated with the development of facial pressure ulcers (FPU) in patients who underwent spine surgery in prone position. A total of 300 cases were studied. The incidence of FPU after prone spine surgery using head padded device >3 hours was 27.3%. Hypotension, higher temperature, prolonged operation time, and much crystalloid therapy were the independent risk factors.